SRHR Vulnerabilities among Refugees and Migrants

Refugees and migrants face concerning vulnerabilities in regards to enjoying their sexual and reproductive health and rights (SRHR). This is driven by many factors rooted in displacement, socio-economic hardship, and systemic barriers. The unplanned displacement often results in the disruption of essential healthcare services, with the WHO reporting that only 55% of health facilities in conflict-affected zones remain functional, thereby limiting access to vital SRHR care (WHO, 2022). This is compounded by legal and policy restrictions; over 60 countries impose restrictive laws on reproductive health services for non-citizens (UNHCR, 2021).

Majority of the refugees and migrant populations face language and cultural barriers which significantly hinder effective communication between them and healthcare providers. For example, a study in Lebanon indicated that nearly half (48%) of Syrian refugee women struggled to understand available SRHR services due to language differences, reducing service utilization (UNFPA, 2020). In addition, most the refugees and migrants are poor; with approximately 84% of refugees living below the poverty line in host countries, hence their ability to afford contraception and maternal health services is severely limited (World Bank, 2022).

Gender-based violence (GBV) remains alarmingly prevalent, with UNHCR estimating that up to 50% of women in conflict zones experience some form of GBV, including sexual violence, during displacement (UNHCR, 2021). Such violence directly impacts SRHR, leading to increased risks of sexually transmitted infections, unintended pregnancies, and trauma. Additionally, a lack of accurate SRHR information and education leaves displaced populations vulnerable to misconceptions and risky behaviors; a survey by IOM found that 70% of displaced women lacked knowledge about contraceptive options (IOM, 2019).

Stigma and discrimination, especially related to gender and health status, further discourage refugees from seeking care. WHO data indicates that stigma surrounding HIV and reproductive health issues reduces service uptake by 30-50% among vulnerable groups (WHO, 2018). Overcrowded and insecure living environments, often characteristic of refugee camps, contribute to increased health risks, with UNHCR reporting that 60% of refugees reside in overcrowded settlements with poor sanitation and limited privacy (UNHCR, 2020).

Psychosocial stress, trauma, and mental health conditions are pervasive, affecting up to 40% of refugees and impeding their ability to make informed SRHR decisions (WHO, 2021). The scarcity of female healthcare providers, particularly in resource-limited settings, acts as an additional barrier; in many contexts, women’s access to culturally sensitive care is hampered by the lack of trained female providers, with reports indicating less than 20% of healthcare staff in some refugee settings are women (ICRC, 2020). The cumulative impact of these factors manifests in significant SRHR challenges.

International Frameworks Supporting Access to SRHR for Refugees and Migrants

The protection and promotion of SRHR for refugees and migrants are underpinned by several key international legal and policy frameworks that emphasize the rights of displaced populations to access comprehensive health services, including reproductive health. The 1951 Refugee Convention and its 1967 Protocol establish the fundamental rights of refugees, including the right to health, which encompasses SRHR, in Article 23 and 24. These instruments oblige signatory states to provide adequate medical care to refugees and ensure their health needs are met without discrimination. Additionally, the Global Compact on Refugees (2018) underscores the importance of integrating SRHR into national refugee response plans, advocating for equitable access to health services as a cornerstone of refugee protection.

Beyond refugee-specific agreements, broader human rights instruments reinforce these commitments. The Universal Declaration of Human Rights (UDHR) states in Article 25 that everyone has the right to a standard of living adequate for health and well-being, including medical care. The International Covenant on Economic, Social and Cultural Rights (ICESCR) further emphasizes the right to the highest attainable standard of physical and mental health, obliging states to eliminate barriers to SRHR services (UN, 1966). These frameworks collectively reinforce the obligation of governments and international agencies to prioritize SRHR for all, including refugees and migrants.

The World Health Organization (WHO) plays a pivotal role through its Global Strategy on Women’s, Children’s and Adolescents’ Health (2016-2030), which advocates for universal health coverage that includes SRHR services for vulnerable populations. The WHO’s “Standards for Sexual and Reproductive Health Services for Refugees and Migrants in Humanitarian Settings” (2019) provides operational guidance to ensure culturally sensitive, accessible, and high-quality SRHR services in humanitarian contexts. Similarly, the United Nations High Commissioner for Refugees (UNHCR) has adopted policies and guidelines emphasizing that refugees have the right to access comprehensive reproductive health services, including family planning, maternal health, and GBV services, regardless of their legal status (UNHCR, 2020).

Furthermore, the Sustainable Development Goals (SDGs), particularly Goal 3 (Good Health and Well-being) and Goal 5 (Gender Equality), explicitly commit to universal access to SRHR. Target 3.7 aims to ensure universal access to sexual and reproductive health-care services, including for vulnerable populations like refugees and migrants. These global commitments, reinforced through international treaties and guidelines, provide a robust legal and policy foundation advocating for the rights of displaced populations to access essential SRHR services.

SRHR challenges faced by Refugees and Migrants:

The following are the most common SRHR challenges faced by Refugees and Migrant population:

• Unintended Pregnancies and Lack of Contraceptive Access: Limited availability of contraceptives and services leads to high rates of unintended pregnancies among the displaced women and girls. A study in Yemen found that 75% of pregnancies among displaced women were unplanned due to restricted access to family planning (UNFPA, 2019).
• Sexual Violence and GBV: The incidence of sexual violence is alarmingly high, with UNHCR estimating that up to 50% of women in conflict zones experience some form of GBV, often resulting in trauma, STIs, or unwanted pregnancies (UNHCR, 2021).
• Maternal and Neonatal Health Risks: Displaced women face higher maternal mortality rates, about 200 per 100,000 live births, compared to 137 in stable settings, due to inadequate prenatal and delivery care (WHO, 2022).
• STIs and HIV/AIDS: Refugees and migrants are at increased risk for STIs, including HIV, due to unsafe sexual practices and limited testing/treatment. UNAIDS reports that in some refugee populations, HIV prevalence is twice that of the general population, primarily due to lack of access to prevention and care (UNAIDS, 2022).
• Unsafe Abortions: Due to legal restrictions and limited services, many women resort to unsafe abortions. WHO estimates that unsafe abortions account for 13% of maternal deaths worldwide, with refugees being particularly vulnerable (WHO, 2018).
• Disrupted Menstrual Care: Inadequate access to menstrual hygiene products and gynecological services increases risks of infections and other health issues, especially in overcrowded settings (UNHCR, 2020).
• Child Marriage: Economic hardship and insecurity have led to increased child marriage among refugees, which adversely affects adolescent girls’ SRHR, including early pregnancy and exposure to GBV. UNICEF reports a 10-15% increase in child marriage in displaced populations (UNICEF, 2021).
• Psychosocial and Mental Health Issues: Mental health challenges are prevalent, with 30-40% of refugees experiencing depression or PTSD, impacting their SRHR and willingness or ability to seek care (WHO, 2021).

Main recommended actions to improve access to SRHR services for refugees and migrants;

• Ensure that SRHR needs of the refugees and migrant populations are integrated in the national health plans and policies, creating clear channels of accountability for service delivery. Additionally, the host government also need to eliminate impediment to access essential SRHR services, including emergency and routine care.
•  The refugees host governments need to re-orient and re-align the national health systems that can absorb and adapt to the unique needs of displaced populations by ensuring well-equipped health facilities and health workers. 

• There is need for investment in tailored capacity-building for healthcare providers will improve the delivery of respectful, trauma-informed, and high-quality SRHR services.

• The government can also capacitate and re-orient various accessible sites like mobile clinics, community centers, schools, and homes using community health workers (CHWs) and peer educators, who are often more trusted by the community to deliver the SRHR information and services to the refugees and migrant population. 
• Raise awareness among refugees, migrants, and host communities about available SRHR services, their rights, and the importance of seeking care to counter misinformation and stigma. Engage men, husbands, religious leaders, and other community influencers among the refugees and migrant population in SRHR education and discussions to challenge harmful gender norms and promote shared decision-making.

• Implement targeted educational and support programs for adolescent girls and young women the refugees and migrant populations, enhancing their life skills, self-efficacy, and ability to make informed decisions about their sexual and reproductive health.

• Make the services affordable by either providing free or low-cost SRHR services, including contraception, post-abortion care to the full extent of the law, and maternal health services, to mitigate the impact of poverty and economic insecurity on access to essential SRHR services.

In conclusion, addressing the SRHR needs of refugees and migrants is a critical component of ensuring their dignity, health, and human rights. The numerous vulnerabilities faced by displaced populations, ranging from legal and cultural barriers to violence and inadequate services, highlight the urgent need for comprehensive, accessible, and culturally sensitive interventions.